Here's a concerning article in today's NEJM:
Artemisinin Resistance in Plasmodium falciparum Malaria
Malaria falciparum is resistant in most of the world to Chloroquin. Now researchers in Thailand have found resistanceto the Artemisinin therapy.
"Conclusions P. falciparum has reduced in vivo susceptibility to artesunate in western Cambodia as compared with northwestern Thailand. Resistance is characterized by slow parasite clearance in vivo without corresponding reductions on conventional in vitro susceptibility testing. Containment measures are urgently needed. "
Thursday, July 30, 2009
Monday, July 27, 2009
HIV and Immigration laws
This article recently appeared in the Global Health Magazine (published by the Global Health Council) and discusses the ban on HIV positive individuals entering the USA.
http://www.globalhealthmagazine.com/guest_blog/barring_none_overturning_HIV_travel_restrictions/
The current restrictions as listed in the article state:
The United States travel and immigration ban disallows the entry of HIV-positive non-citizens into the country and prohibits HIV positive non-citizens from becoming permanent legal residents.
The Department of Health and Human Services is proposing to remove HIV from the list of communicable diseases disallowing entry into the United States; however, it is uncertain when this might take place.
What do you think about the proposed change and implications on public health policy? Did you know that the United States does not allow entry of HIV positive non-citizens and prevents HIV positive individuals from becoming citizens?
http://www.globalhealthmagazine.com/guest_blog/barring_none_overturning_HIV_travel_restrictions/
The current restrictions as listed in the article state:
The United States travel and immigration ban disallows the entry of HIV-positive non-citizens into the country and prohibits HIV positive non-citizens from becoming permanent legal residents.
The Department of Health and Human Services is proposing to remove HIV from the list of communicable diseases disallowing entry into the United States; however, it is uncertain when this might take place.
What do you think about the proposed change and implications on public health policy? Did you know that the United States does not allow entry of HIV positive non-citizens and prevents HIV positive individuals from becoming citizens?
Friday, July 24, 2009
Global Health Ideas
42 Extremely Affordable Global Health Innovations
Folks are developing USB-based Ultrasound probes, low
cost and low energy usage stoves, and lots of other neat ideas.
Also, a new report on the state of Food Insecurity was just released.
"Food security in 70 developing countries is projected to deteriorate over the next decade, according to USDA’s Economic Research Service. After rising nearly 11 percent from 2007 to 2008, the number of food-insecure people in the developing countries analyzed by ERS researchers is estimated to rise to 833 million in 2009, an almost 2-percent rise from 2008 to 2009. Despite a decline in food prices in late 2008, deteriorating purchasing power and food security are expected in 2009 because of the growing financial deficits and higher inflation that have occurred in recent years. Food-insecure people are defined as those consuming less than the nutritional target of 2,100 calories per day per person."
Wednesday, July 22, 2009
"Search for the Afghan Girl"
Palmer Museum of Art at State College will be screening the National Geographic film, Search for the Afghan Girl. This will be showing at the Palmer Museum of Art at 1pm every Sunday this summer between July 5 and August 16.
Also be sure to check out "Face of Asia", an exhibit of photographs by Steve McCurry, June 21-August 16.
Monday, July 20, 2009
Update from India
Here's the latest from Laura Spece as she finishes her time in India. She recounts several very difficult experiences from her trip as well as describes the community health worker program she observed:
Salam! (I've just learned that Namaste is for Hindus, Salam is the
proper hello for Muslims)
Sorry it's been so long since my last update, but things have gotten a
little hectic. I just finished the public health class yesterday, and
they had plenty of work for us to do up until then. We also painted a
mural on the wall of the pediatric ward of the new hospital (info. to
follow). Plus the pre-monsoon, "slow" rains have started to become a
more frequent, daily occurrence. Which unfortunately means power
interruptions, lost internet and a ton of mud (mixed with cow dung, of
course). Sum it all together and it's made life a whole new
adventure. Monsoon must be REALLY fun here. :) Actual monsoon rains
have reportedly started in Mumbai, which means the city is flooded.
The news report out here "in the sticks" states that the water height
can be as high as your waist! But we were also warned of
exaggerations...
So I leave Jamkhed tomorrow, which is making me quite sad. I'll
travel just a bit before coming back to the States; a day in Mumbai
(thank you Del and Bob and Aditi!), 5 days in Kochin, Kerala, then 4
days in Delhi with a day trip out to Agra for the Taj Mahal. I'm
excited to see more of India, but I will greatly miss the CRHP. I
wish I had more time to stay here; to meet more of the village health
workers and to see how Drs. Arole transition into the new hospital.
But alas, school starts soon. Unless you think I could convince Dean
Simons to let me attend med school remotely for awhile (kidding, I
miss home a lot too). :)
Which brings me to what I want to discuss. I figured this e-mail
should focus a bit on the Comprehensive Rural Health Project; in what
they do, how they got started and where they're headed. Plus I'll
throw in how I feel personally about my experience along the way...
The CRHP was started in 1970 by Dr. Raj and Mabelle Arole. They
attended the Christian Medical College in Valor, and actually met
there and got married. They also completed Masters in Public Health
degrees at Johns Hopkins. They decided they wanted to work in
poverty-stricken rural India, instead of pursuing higher-paid, more
academically respected positions in the cities. They sort of fell
upon Jamkhed, in the state of Maharashtra. Jamkhed is a small "city"
that actually sought out the Aroles shortly after they arrived in the
area, hearing rumors that they wanted to start a hospital. Some land
was donated for a small clinic by the community, and more land was
added over time to accommodate the growth of the project. We saw the
original "clinic" in town the other week, it was no bigger than my
garage. From the start, the Arole's took a community approach and
focused on delivering primary health care to the villages surrounding
Jamkhed. The problems were numerous; leprosy, malnutrition, infantile
diarrhea, anemia, maternal deaths during delivery, tuberculosis,
malaria and many, many social issues. It was quickly decided that the
focus should be on nutrition, accessing proper drinking water and
community education. To do this, the Arole's first used well-educated
(by India's standards, most girls at the time barely finished 4th
grade) Auxilary Nurse Midwives. Problem is, the ANMs didn't want to
stay and live in rural Indian villages! Plus, they couldn't relate to
the villagers at all, and were more likely to abide by strict
caste-discriminatory practices. So lo and behold, the Arole's decided
to train ILLITERATE, UNTOUCHABLE, 40+ year old WOMEN!!! These 4
categories were some of the most down-trodden of all Indian society.
And how do you teach someone who can't read or write?? Well, they
brought the women to CRHP to learn by flashcards, drawings, shadowing
the Drs. Arole on rounds through the hospital and they even dissected
a goat! The VHWs use many of the same techniques to then go out and
educate the communities. Except they use more songs and skits...
instead of goats. :)
And it's worked. Over the last 30 years, infant mortality has dropped
by 20%, malnutrition rates are 30% below the Indian national baseline
and the CRHP now serves over 300 villages in Maharashtra alone. All
accomplished by education via flashcards, drilling tube wells, making
drainage pits for standing water and community empowerment. Plus the
CRHP is helping other impoverished states start similar programs as
well. They estimate their patient coverage to nearly 400,000 people!
The social ramifications have also been vast. Women have become much
more empowered, alcoholism is down, literacy rates are climbing, age
at marriage is increasing and so are the number of girls going to
school. The female Village Health Workers I have met are
unbelievable. They are so fiesty, assertive, proud and HAPPY! It's a
real treat to sit and talk with them, and even to observe them in
their weekly class. Watching classes is also beautiful because they
are all wearing their best sarees (the customary dress of married
women, where you wrap yourself in 16 feet of chiffon or silk), which
is the most colorful sight ever. I did purchase a saree here in
Jamkhed, it's a fuschia-ish color. It took me 5 tries to get it
wrapped around myself, and even then the dining hall ladies yanked me
back into the kitchen to re-wrap me. :) At least I'm entertaining.
You do wear a petticoat beneath it, with a tailor-made blouse.
Walking in it is a work-out. The effective diameter of the skirt is
pretty small, and there is a bulk of material in pleats on the front.
I was minor-ly afraid of tipping over. But never fear, I'm sure
you'll all get to see it. I plan to use it for any presentations I
make in the future...I need a good excuse to wear it. :) To read more
about the VHWs, the CRHP was featured in the National Geographic
article, "Necessary Angels" last December:
http://ngm.nationalgeographic.com/2008/12/community-doctors/rosenberg-text
But there are things that I've seen and experienced that have jarred
me a bit. First it is just awkward to be a Western female in this
area. For example, when I tried to buy a T-shirt from the
"department" store to get the CRHP logo printed on it, the gentlemen
at the counter nearly fell over when I held it up to my chest to see
if it fit. He couldn't believe the T-shirt was for me, since T-shirts
are for men only. Pants are also for men only, unless ladies wear a
kurta (a long, dress-like shirt that goes almost to your knees) to
cover the pelvic area. Ankles are usually a no-no and knees are
positively obscene. So when the temperatures hits 40 degrees Celsius,
I'm still expected to wear pants + kurta and a little scarf. NO
shorts. Ugh. Add to the fact that I'm pale with blue eyes, I've
caused quite a stir. You see, the illegal DVD-copying industry is
quite prolific in India. And since most of rural India has never seen
a white woman in real-life, the only exposure is through Western media
(think old re-runs of "Friends") and ummm, well, how do you say this?
Smutty movies. Great. Not a good image. When I was walking in town
with a few other students, one man fell off his motorcycle as he
rubber-necked to see the gaggle of super-pale foreign girls. Yikes.
In all honesty though, I haven't had much trouble at all. Jamkhed and
the villages are really getting used to foreign women coming through
for classes on an increasing basis. So I've been treated very, very
well and am probably quite spoiled, really. Things are supposedly
much different in the cities of India (Mumbai and Delhi), so I'm
interested to see it.
***This e-mail has taken me a few days to finish, so I'm actually in
Mumbai currently and it is WONDERFUL! I do feel like I sort of
"wandering out of the bush" as I left Jamkhed and went straight to the
big city. :)
The second most bothersome thing to me was the lack of secondary
(hospital-level) care, here in rural India. It's the one thing Dr.
Raj has not yet been able to accomplish, and he regrets it heavily.
(Though he also admitted to a 2nd regret later on; a lack of general
plumbing system for the villages) The hospital that was in use (until
yesterday) had only 12 beds and lacked a lot of medical necessities.
The operating theatre was an interesting experience, since there was
no air conditioning or real ventilation. While observing (I did get
to hold a retractor), the smell and heat sometimes made my knees
buckle a little. And to suture your skin back up? Cotton thread with
a regular sewing needle. No joke, the kind you'd repair your shirt
with. But the thread is maybe a little thicker. But they did have
*cat gut* (absorbable) suture for your insides. :) They had one
warming table for infants, but lacked an incubator and other life
support necessities in a small enough size. So premies were pretty
much screwed. I've observed a lot of injuries and diseases I probably
won't see too frequently in the states (think being gored by a water
buffalo, multiples traumas from motorcycle accidents, and
extra-pulmonary tuberculosis, leprosy). The most common surgery falls
into the ob/gyn category; hysterectomies, D&C, Cesareans, forceps
delivery and of course, vaginal deliveries the good old fashioned way.
Though most deliveries (at least 80%) are done at home and go well
since the VHWs are also trained as birth attendants. Prenatal care is
taking root so they've been pretty successful at figuring out if the
pregnancy is high-risk, and schedule the delivery to be done at the
hospital. For home births, the VHWs are given sterilized packets
wrapped in saree material to take to the home, including: razorblade
(for the cord), string, gauze and a suction device for the baby's
nose/mouth if needed. I did see one delivery end badly, and it
bothered me a great deal. The mother was from a village not covered
by the CRHP model and she was severely anemic upon arrival (and
probably has been for most of her life). Since she's not too
accustomed to hospitals and pretty freaked out, she refused blood and
was giving a lot of trouble when Dr. Wout wanted to examine her
cervix. Dr. Wout couldn't find a fetal heart sound, so he did an
episotomy and yanked the baby out with forceps. They do episotomies
sideways here, towards the thigh. They say American episotomies are a
joke, so to all of the docs on this list, please comment. The baby
was "extracted" in probably 15 seconds, but came out completely blue.
I never saw anything so unnatural. Dr. Wout and the staff tried very
hard to save him, but to no avail. I was (and still sort of am)
pretty disturbed. Can't help but think that things would have been
different if this women wasn't born into extreme poverty in rural
India. Plus I had no idea how to properly comfort this woman since I
don't know the language well enough, nor what is entirely culturally
acceptable in the area. It's something I'm going to consider heavily
when I decide to work globally in the future.
The problem with the CRHP hospital is, it takes money. Lots of money.
While the primary care and VHW model is really sustainable (the VHWs
work on a volunteer basis), a hospital doesn't run on volunteer
doctors. You need doctors to permanently staff it, to keep some
continuity. And if you can't even get Auxilary Nurse Midwives (a
certificate, less than an American LPN) to stay, how on earth can you
convince a physician. Let alone afford their salary if specialized.
So that's the next phase of CRHP. They built a beautiful, 50-bed
hospital with excellent operating theatres and plenty of new machinery
for their lab, X-ray and life support.
So here's where I finally ask for your help. When I get home, I want
to try to raise $$ for CRHP to send a girl (maybe more, if possible)
to a 3-year nursing school. Ravi (the Arole's son) has a connection
with a University in Pune and in Indore to accept the village girls
(who perform educationally at a much lower level than the city girls
do) and also gets a discount on tuition. So the total cost to train
one 20+ year old, Dalit (untouchable) and super-poor village girl as
the English equivalent of an RN is $4000. This figure includes both
tuition and all living expenses for 3 years. The goal is to have the
girl attend University (which is normally impossible for them) and
then have them come back and work at CRHP. I feel this would be one
of the best ways I could help CRHP achieve the sustainability they so
desperately need, and Ravi and Dr. Raj agree. I have one person who
has already pledged to donate a good chunk of the $4000 needed. So if
you've enjoyed reading my e-mails, I encourage you to donate to the
CRHP to this end. But they need tons of other stuff as well, both for
the hospital and in the villages. You can find a list of needed
goods, and the link to make your tax-deductible donation at their
website, as well as more info. on CRHP:
www.jamkhed.org
Seriously, even $5 goes ridiculously far in the village. And if you
know of any organizations, foundations, church groups or individuals
who might be interested in donating or seeing my presentation
(complete with saree and photos of village life) please let me know.
:)
I return to the States on July 29th, late in the evening. I hope to
catch up with all of you soon. Thank you so much for all of your
thoughts and prayers. It was so helpful and motivating to have all of
your support as I've trekked through these villages.
Dhanyavad,
Laura
Salam! (I've just learned that Namaste is for Hindus, Salam is the
proper hello for Muslims)
Sorry it's been so long since my last update, but things have gotten a
little hectic. I just finished the public health class yesterday, and
they had plenty of work for us to do up until then. We also painted a
mural on the wall of the pediatric ward of the new hospital (info. to
follow). Plus the pre-monsoon, "slow" rains have started to become a
more frequent, daily occurrence. Which unfortunately means power
interruptions, lost internet and a ton of mud (mixed with cow dung, of
course). Sum it all together and it's made life a whole new
adventure. Monsoon must be REALLY fun here. :) Actual monsoon rains
have reportedly started in Mumbai, which means the city is flooded.
The news report out here "in the sticks" states that the water height
can be as high as your waist! But we were also warned of
exaggerations...
So I leave Jamkhed tomorrow, which is making me quite sad. I'll
travel just a bit before coming back to the States; a day in Mumbai
(thank you Del and Bob and Aditi!), 5 days in Kochin, Kerala, then 4
days in Delhi with a day trip out to Agra for the Taj Mahal. I'm
excited to see more of India, but I will greatly miss the CRHP. I
wish I had more time to stay here; to meet more of the village health
workers and to see how Drs. Arole transition into the new hospital.
But alas, school starts soon. Unless you think I could convince Dean
Simons to let me attend med school remotely for awhile (kidding, I
miss home a lot too). :)
Which brings me to what I want to discuss. I figured this e-mail
should focus a bit on the Comprehensive Rural Health Project; in what
they do, how they got started and where they're headed. Plus I'll
throw in how I feel personally about my experience along the way...
The CRHP was started in 1970 by Dr. Raj and Mabelle Arole. They
attended the Christian Medical College in Valor, and actually met
there and got married. They also completed Masters in Public Health
degrees at Johns Hopkins. They decided they wanted to work in
poverty-stricken rural India, instead of pursuing higher-paid, more
academically respected positions in the cities. They sort of fell
upon Jamkhed, in the state of Maharashtra. Jamkhed is a small "city"
that actually sought out the Aroles shortly after they arrived in the
area, hearing rumors that they wanted to start a hospital. Some land
was donated for a small clinic by the community, and more land was
added over time to accommodate the growth of the project. We saw the
original "clinic" in town the other week, it was no bigger than my
garage. From the start, the Arole's took a community approach and
focused on delivering primary health care to the villages surrounding
Jamkhed. The problems were numerous; leprosy, malnutrition, infantile
diarrhea, anemia, maternal deaths during delivery, tuberculosis,
malaria and many, many social issues. It was quickly decided that the
focus should be on nutrition, accessing proper drinking water and
community education. To do this, the Arole's first used well-educated
(by India's standards, most girls at the time barely finished 4th
grade) Auxilary Nurse Midwives. Problem is, the ANMs didn't want to
stay and live in rural Indian villages! Plus, they couldn't relate to
the villagers at all, and were more likely to abide by strict
caste-discriminatory practices. So lo and behold, the Arole's decided
to train ILLITERATE, UNTOUCHABLE, 40+ year old WOMEN!!! These 4
categories were some of the most down-trodden of all Indian society.
And how do you teach someone who can't read or write?? Well, they
brought the women to CRHP to learn by flashcards, drawings, shadowing
the Drs. Arole on rounds through the hospital and they even dissected
a goat! The VHWs use many of the same techniques to then go out and
educate the communities. Except they use more songs and skits...
instead of goats. :)
And it's worked. Over the last 30 years, infant mortality has dropped
by 20%, malnutrition rates are 30% below the Indian national baseline
and the CRHP now serves over 300 villages in Maharashtra alone. All
accomplished by education via flashcards, drilling tube wells, making
drainage pits for standing water and community empowerment. Plus the
CRHP is helping other impoverished states start similar programs as
well. They estimate their patient coverage to nearly 400,000 people!
The social ramifications have also been vast. Women have become much
more empowered, alcoholism is down, literacy rates are climbing, age
at marriage is increasing and so are the number of girls going to
school. The female Village Health Workers I have met are
unbelievable. They are so fiesty, assertive, proud and HAPPY! It's a
real treat to sit and talk with them, and even to observe them in
their weekly class. Watching classes is also beautiful because they
are all wearing their best sarees (the customary dress of married
women, where you wrap yourself in 16 feet of chiffon or silk), which
is the most colorful sight ever. I did purchase a saree here in
Jamkhed, it's a fuschia-ish color. It took me 5 tries to get it
wrapped around myself, and even then the dining hall ladies yanked me
back into the kitchen to re-wrap me. :) At least I'm entertaining.
You do wear a petticoat beneath it, with a tailor-made blouse.
Walking in it is a work-out. The effective diameter of the skirt is
pretty small, and there is a bulk of material in pleats on the front.
I was minor-ly afraid of tipping over. But never fear, I'm sure
you'll all get to see it. I plan to use it for any presentations I
make in the future...I need a good excuse to wear it. :) To read more
about the VHWs, the CRHP was featured in the National Geographic
article, "Necessary Angels" last December:
http://ngm.nationalgeographic.com/2008/12/community-doctors/rosenberg-text
But there are things that I've seen and experienced that have jarred
me a bit. First it is just awkward to be a Western female in this
area. For example, when I tried to buy a T-shirt from the
"department" store to get the CRHP logo printed on it, the gentlemen
at the counter nearly fell over when I held it up to my chest to see
if it fit. He couldn't believe the T-shirt was for me, since T-shirts
are for men only. Pants are also for men only, unless ladies wear a
kurta (a long, dress-like shirt that goes almost to your knees) to
cover the pelvic area. Ankles are usually a no-no and knees are
positively obscene. So when the temperatures hits 40 degrees Celsius,
I'm still expected to wear pants + kurta and a little scarf. NO
shorts. Ugh. Add to the fact that I'm pale with blue eyes, I've
caused quite a stir. You see, the illegal DVD-copying industry is
quite prolific in India. And since most of rural India has never seen
a white woman in real-life, the only exposure is through Western media
(think old re-runs of "Friends") and ummm, well, how do you say this?
Smutty movies. Great. Not a good image. When I was walking in town
with a few other students, one man fell off his motorcycle as he
rubber-necked to see the gaggle of super-pale foreign girls. Yikes.
In all honesty though, I haven't had much trouble at all. Jamkhed and
the villages are really getting used to foreign women coming through
for classes on an increasing basis. So I've been treated very, very
well and am probably quite spoiled, really. Things are supposedly
much different in the cities of India (Mumbai and Delhi), so I'm
interested to see it.
***This e-mail has taken me a few days to finish, so I'm actually in
Mumbai currently and it is WONDERFUL! I do feel like I sort of
"wandering out of the bush" as I left Jamkhed and went straight to the
big city. :)
The second most bothersome thing to me was the lack of secondary
(hospital-level) care, here in rural India. It's the one thing Dr.
Raj has not yet been able to accomplish, and he regrets it heavily.
(Though he also admitted to a 2nd regret later on; a lack of general
plumbing system for the villages) The hospital that was in use (until
yesterday) had only 12 beds and lacked a lot of medical necessities.
The operating theatre was an interesting experience, since there was
no air conditioning or real ventilation. While observing (I did get
to hold a retractor), the smell and heat sometimes made my knees
buckle a little. And to suture your skin back up? Cotton thread with
a regular sewing needle. No joke, the kind you'd repair your shirt
with. But the thread is maybe a little thicker. But they did have
*cat gut* (absorbable) suture for your insides. :) They had one
warming table for infants, but lacked an incubator and other life
support necessities in a small enough size. So premies were pretty
much screwed. I've observed a lot of injuries and diseases I probably
won't see too frequently in the states (think being gored by a water
buffalo, multiples traumas from motorcycle accidents, and
extra-pulmonary tuberculosis, leprosy). The most common surgery falls
into the ob/gyn category; hysterectomies, D&C, Cesareans, forceps
delivery and of course, vaginal deliveries the good old fashioned way.
Though most deliveries (at least 80%) are done at home and go well
since the VHWs are also trained as birth attendants. Prenatal care is
taking root so they've been pretty successful at figuring out if the
pregnancy is high-risk, and schedule the delivery to be done at the
hospital. For home births, the VHWs are given sterilized packets
wrapped in saree material to take to the home, including: razorblade
(for the cord), string, gauze and a suction device for the baby's
nose/mouth if needed. I did see one delivery end badly, and it
bothered me a great deal. The mother was from a village not covered
by the CRHP model and she was severely anemic upon arrival (and
probably has been for most of her life). Since she's not too
accustomed to hospitals and pretty freaked out, she refused blood and
was giving a lot of trouble when Dr. Wout wanted to examine her
cervix. Dr. Wout couldn't find a fetal heart sound, so he did an
episotomy and yanked the baby out with forceps. They do episotomies
sideways here, towards the thigh. They say American episotomies are a
joke, so to all of the docs on this list, please comment. The baby
was "extracted" in probably 15 seconds, but came out completely blue.
I never saw anything so unnatural. Dr. Wout and the staff tried very
hard to save him, but to no avail. I was (and still sort of am)
pretty disturbed. Can't help but think that things would have been
different if this women wasn't born into extreme poverty in rural
India. Plus I had no idea how to properly comfort this woman since I
don't know the language well enough, nor what is entirely culturally
acceptable in the area. It's something I'm going to consider heavily
when I decide to work globally in the future.
The problem with the CRHP hospital is, it takes money. Lots of money.
While the primary care and VHW model is really sustainable (the VHWs
work on a volunteer basis), a hospital doesn't run on volunteer
doctors. You need doctors to permanently staff it, to keep some
continuity. And if you can't even get Auxilary Nurse Midwives (a
certificate, less than an American LPN) to stay, how on earth can you
convince a physician. Let alone afford their salary if specialized.
So that's the next phase of CRHP. They built a beautiful, 50-bed
hospital with excellent operating theatres and plenty of new machinery
for their lab, X-ray and life support.
So here's where I finally ask for your help. When I get home, I want
to try to raise $$ for CRHP to send a girl (maybe more, if possible)
to a 3-year nursing school. Ravi (the Arole's son) has a connection
with a University in Pune and in Indore to accept the village girls
(who perform educationally at a much lower level than the city girls
do) and also gets a discount on tuition. So the total cost to train
one 20+ year old, Dalit (untouchable) and super-poor village girl as
the English equivalent of an RN is $4000. This figure includes both
tuition and all living expenses for 3 years. The goal is to have the
girl attend University (which is normally impossible for them) and
then have them come back and work at CRHP. I feel this would be one
of the best ways I could help CRHP achieve the sustainability they so
desperately need, and Ravi and Dr. Raj agree. I have one person who
has already pledged to donate a good chunk of the $4000 needed. So if
you've enjoyed reading my e-mails, I encourage you to donate to the
CRHP to this end. But they need tons of other stuff as well, both for
the hospital and in the villages. You can find a list of needed
goods, and the link to make your tax-deductible donation at their
website, as well as more info. on CRHP:
www.jamkhed.org
Seriously, even $5 goes ridiculously far in the village. And if you
know of any organizations, foundations, church groups or individuals
who might be interested in donating or seeing my presentation
(complete with saree and photos of village life) please let me know.
:)
I return to the States on July 29th, late in the evening. I hope to
catch up with all of you soon. Thank you so much for all of your
thoughts and prayers. It was so helpful and motivating to have all of
your support as I've trekked through these villages.
Dhanyavad,
Laura
Monday, July 13, 2009
Global Health Articles from The Lancet
A few articles to consider:
A commentary on the Gates Foundation's priorities for Global Health. The authors argue that the funds are too heavily weighted on new technologies that will take decades to produce, whereas "two-thirds of global child deaths could be prevented if existing interventions were fully implemented..." Currently over 10 million children die each year. The vast majority of these are preventible. The authors also take issue with the 'poor correlation between fudning and childhood diesease burden." Again, where the Gates Foundation has a strong focus on select diseases (malaria, TB, HIV) the majority of child deaths are due to different diseases: pneumonia, diarrhea, malnutrition. The Lancet Editorial has words of both praise and admonition. An original paper looks at how the Gates Foundation is spending its money, and who it is giving its money to, concluding: "The findings of this report raise several questions
about the foundation’s global health grant-making programme, which needs further research and assessment."
In 2004 the WHO published a handbook on Home-Management of Malaria.
"Home management of malaria is the presumptive treatment of febrile children with prepackaged antimalarial drugs that have been distributed to households by members of the community; diagnostic tests are not used." Rural areas have been targets of this intervention due to higher incidence of malaria and poorer access to health services. An original article in The Lancet looked at home management in urban Uganda. The authors concluded:
"Although home management of malaria led to prompt treatment of fever, there was little eff ect on clinical outcomes. The substantial over-treatment suggests that artemether-lumefantrine provided in the home might not be appropriate for large urban areas or settings with fairly low malaria transmission." However, a commentary disagreed.
Finally, a letter from the Director-General of WHO, Margaret Chan, argues the case for "Primary health care as a route to health security."
A commentary on the Gates Foundation's priorities for Global Health. The authors argue that the funds are too heavily weighted on new technologies that will take decades to produce, whereas "two-thirds of global child deaths could be prevented if existing interventions were fully implemented..." Currently over 10 million children die each year. The vast majority of these are preventible. The authors also take issue with the 'poor correlation between fudning and childhood diesease burden." Again, where the Gates Foundation has a strong focus on select diseases (malaria, TB, HIV) the majority of child deaths are due to different diseases: pneumonia, diarrhea, malnutrition. The Lancet Editorial has words of both praise and admonition. An original paper looks at how the Gates Foundation is spending its money, and who it is giving its money to, concluding: "The findings of this report raise several questions
about the foundation’s global health grant-making programme, which needs further research and assessment."
In 2004 the WHO published a handbook on Home-Management of Malaria.
"Home management of malaria is the presumptive treatment of febrile children with prepackaged antimalarial drugs that have been distributed to households by members of the community; diagnostic tests are not used." Rural areas have been targets of this intervention due to higher incidence of malaria and poorer access to health services. An original article in The Lancet looked at home management in urban Uganda. The authors concluded:
"Although home management of malaria led to prompt treatment of fever, there was little eff ect on clinical outcomes. The substantial over-treatment suggests that artemether-lumefantrine provided in the home might not be appropriate for large urban areas or settings with fairly low malaria transmission." However, a commentary disagreed.
Finally, a letter from the Director-General of WHO, Margaret Chan, argues the case for "Primary health care as a route to health security."
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